Douglas A Nuckols, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

01052220A Issued in IN

Practice address

10021 Dupont Circle CT
Fort Wayne, IN 46825-1604

Phone

(260) 426-8117

Fax

(260) 420-0817

NPI assigned

Aug 17, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH, IN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Otolaryngology

Education

Indiana University School of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ear Nose and Throat Associates PCGroup PAC ID 3375504301, 36 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021
• Lutheran Hospital of Indiana Hospital, Fort Wayne, IN, CCN 150017
• Parkview Whitley Hospital Hospital, Columbia City, IN, CCN 150101
• Kosciusko Community Hospital Hospital, Warsaw, IN, CCN 150133
• Community Hospitals and Wellness Centers Hospital, Bryan, OH, CCN 360121

Merit-based Incentive Payment System (MIPS)

Final score

83.18 of 100Reported as individual

Quality

73.24

Promoting interoperability

93

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dnuckols@entfortwayne.gwaydirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ear, Nose & Throat Associates, PC

  • Otolaryngology Physician
  • Fort Wayne, IN
  • NPI 1851377691

  OH

  Medicare reassignment Care Compare group NPD
• The Hearing Center LLC

  • Audiologist
  • Fort Wayne, IN
  • NPI 1891771655
  NPD (past)
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Iom Health System LP

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1306897335
  Care Compare affiliation
• Parkview Hospital, Inc.

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1366407603
  Care Compare affiliation
• Warsaw Health System LLC

  • General Acute Care Hospital
  • Warsaw, IN
  • NPI 1164475711
  Care Compare affiliation
• Whitley Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Columbia City, IN
  • NPI 1205844495
  Care Compare affiliation
• Whitley Memorial Hospital, Inc.

  • Land Ambulance
  • Columbia City, IN
  • NPI 1497764450

  Hospital

  Care Compare affiliation
• Community Hospitals and Wellness Centers

  • General Acute Care Hospital
  • Bryan, OH
  • NPI 1962458521
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258675200000",
    "number": "1982696837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10021 DUPONT CIRCLE CT",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251604",
            "telephone_number": "260-426-8117",
            "fax_number": "260-420-0817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10021 DUPONT CIRCLE CT",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251604",
            "telephone_number": "260-426-8117",
            "fax_number": "260-420-0817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUCKOLS",
        "first_name": "DOUGLAS",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-17",
        "last_updated": "2009-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IN",
            "license": "01052220A",
            "primary": true
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "OH",
            "license": "35-07-8501",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200262190",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2207543",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph Scott Novotney, MA, LMHC
• Sandra D Nowlin, MA
• NSS-Alf Fort Wayne LLC
• Candace Ntiamoah, FNP
• Jennifer E Nuce, MA
• Amy E. Nugent, NP
• Leah Nugent
• Andrea Numbers, DMD
• Tiffani Nunn
• Nurse Johnson Transportation LLC

• Otolaryngology Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Otolaryngology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.